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1.
Semin Vasc Surg ; 32(1-2): 14-17, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31540649

RESUMO

The recognition of vascular surgery as an independent surgical specialty is inevitable, but the pathway to full autonomy remains uncertain. Vascular surgery emerged from general surgery in the mid-1950s with the advent of synthetic grafts and microvascular techniques. By the early 1980s, Accreditation Council for Graduate Medical Education-approved fellowships were established in most large academic medical centers. The American Board of Surgery recognized this additional specialty training by awarding vascular graduates a Certificate of Special Qualifications distinguishing them from general surgeons. The emergence of endovascular surgery radically changed the face of vascular surgery from a general surgery subspecialty to a unique surgical specialty with a growing array of minimally invasive tools. With the establishment of a primary Certificate in Vascular Surgery and the subsequent development of integrated residencies, vascular surgery moved ever closer to recognition as an independent surgical specialty. Despite the remarkable progress that has been observed over the past 50 years, there is a desire in the vascular community for formal recognition of the unique body of knowledge and surgical skills that serve as the foundation of contemporary vascular care.


Assuntos
Educação de Pós-Graduação em Medicina/métodos , Autonomia Profissional , Conselhos de Especialidade Profissional , Cirurgiões/educação , Procedimentos Cirúrgicos Vasculares/educação , Competência Clínica , Currículo , Educação de Pós-Graduação em Medicina/história , Educação de Pós-Graduação em Medicina/normas , Educação de Pós-Graduação em Medicina/tendências , Previsões , História do Século XX , História do Século XXI , Humanos , Conselhos de Especialidade Profissional/história , Conselhos de Especialidade Profissional/normas , Conselhos de Especialidade Profissional/tendências , Cirurgiões/história , Cirurgiões/normas , Cirurgiões/tendências , Estados Unidos , Procedimentos Cirúrgicos Vasculares/história , Procedimentos Cirúrgicos Vasculares/normas , Procedimentos Cirúrgicos Vasculares/tendências
2.
Implement Sci ; 14(1): 70, 2019 07 08.
Artigo em Inglês | MEDLINE | ID: mdl-31286964

RESUMO

BACKGROUND: Many interventions used in health care lack evidence of effectiveness and may be unnecessary or even cause harm, and should therefore be de-implemented. Lists of such ineffective, low-value practices are common, but these lists have little chance of leading to improvements without sufficient knowledge regarding how de-implementation can be governed and carried out. However, decisions regarding de-implementation are not only a matter of scientific evidence; the puzzle is far more complex with political, economic, and relational interests play a role. This project aims at exploring the governance of de-implementation of low-value practices from the perspectives of national and regional governments and senior management at provider organizations. METHODS: Theories of complexity science and organizational alignment are used, and interviews are conducted with stakeholders involved in the governance of low-value practice de-implementation, including national and regional governments (focusing on two contrasting regions in Sweden) and senior management at provider organizations. In addition, an ongoing process for governing de-implementation in accordance with current recommendations is followed over an 18-month period to explore how governance is conducted in practice. A framework for the governance of de-implementation and policy suggestions will be developed to guide de-implementation governance. DISCUSSION: This study contributes to knowledge about the governance of de-implementation of low-value care practices. The study provides rich empirical data from multiple system levels regarding how de-implementation of low-value practices is currently governed. The study also makes a theoretical contribution by applying the theories of complexity and organizational alignment, which may provide generalizable knowledge about the interplay between stakeholders across system levels and how and why certain factors influence the governance of de-implementation. The project employs a solution-oriented perspective by developing a framework for de-implementation of low-value practices and suggesting practical strategies to improve the governance of de-implementation. The framework and strategies can thereafter be evaluated for validity and impact in future studies.


Assuntos
Tomada de Decisões , Assistência à Saúde/normas , Fechamento de Instituições de Saúde/métodos , Administração de Serviços de Saúde , Autonomia Profissional , Qualidade da Assistência à Saúde/normas , Humanos , Entrevistas como Assunto , Modelos Teóricos , Política Organizacional , Formulação de Políticas , Suécia
3.
Nurse Educ Pract ; 38: 145-152, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31284217

RESUMO

Role competence and patient safety (PS) competence among healthcare professionals are rapidly developing issues due to increasing patient acuity and complexity in the healthcare system. Upon graduation, nurse practitioners (NP) provide autonomous healthcare for populations with complex health needs, thus role and PS competence is imperative. The study aim was to test a hypothesized model of the relationships between educational structural empowerment (SE), psychological empowerment (PE), NP role competence, and PS competence. The sample was drawn from newly graduated NPs from across Canada, accessed through twenty professional nurse organizations. The study survey included socio-demographic questions, the Conditions of Learning Effectiveness Questionnaire, the PE Scale, the NP Competence Survey, and the Health Processional Education in PS Survey. One hundred and ninety Canadian educated NPs who completed their studies in the preceding 2-year time period responded. The study model tested the effect of educational SE on NP role competence and PS competence partially mediated by PE. PE partially mediated the positive relationship for educational SE and PS competence, yet no mediation effect occurred for educational SE and NP role competence. Nurse educators need to consider educational SE strategies as NPs' positive perceptions of role competence have the potential to influence greater levels of PS competence.


Assuntos
Competência Clínica/normas , Poder (Psicologia) , Adulto , Atitude do Pessoal de Saúde , Canadá , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Profissionais de Enfermagem , Segurança do Paciente , Autonomia Profissional , Inquéritos e Questionários
4.
Nurs Adm Q ; 43(3): 230-245, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31162342

RESUMO

The primary aim of this literature review was to examine the quantity, quality, and consistency of evidence regarding the span of control (SOC) specific to nurse managers. A secondary aim was to meaningfully translate the evidence and offer guidance to 21st-century nurse leaders. The review results were categorized using Donabedian's (2003) Structure-Process-Outcomes model. The Structure-Process-Outcomes approach was used to review the literature and consider SOC recommendations for today's health care environment. Structures outlined the conditions for current SOC, which included material resources, human resources, and organizational characteristics. Processes were defined as activities or actions stemming from identified structures that led to outcomes. Examples included management/administrative activities, as well as frontline staff participation in these tasks. Outcomes were performance measures of human resources, financial, and quality metrics. The review revealed that an SOC model built on a simplistic full-time employment ratio is outdated. Yet, nurse managers remain in their role in the face of these simplistic models despite feelings of inadequacy, exhaustion, and failure because they passionately care about patients and staff. New attitudes and integration of advanced technologies, pioneering tools including SOC assessment tools, and ongoing competency developments will result in different needs of SOC as health care moves deeper into the modern era. This evidence is offered to inform and drive conversations focused on providing optimal nurse manager SOC for maximum effectiveness within unique and ever-evolving care environments.


Assuntos
Liderança , Enfermeiras Administradoras/psicologia , Atitude do Pessoal de Saúde , Humanos , Autonomia Profissional , Local de Trabalho/psicologia , Local de Trabalho/normas
5.
BMC Public Health ; 19(1): 758, 2019 Jun 14.
Artigo em Inglês | MEDLINE | ID: mdl-31200675

RESUMO

BACKGROUND: This study aims to explore the development of job demands, decision authority and social support within and between industries with different gender composition in Sweden between 1991 and 2013. METHODS: Cross-sectional data from 12 waves of the Swedish Work Environment Surveys (1991 to 2013), comprising in total 109,698 respondents, were used. Industries were classified in 7 categories according to its gender composition and main activity, comprising two female-dominated, three gender-mixed and two male-dominated industries. Proportions of workers reporting high job demands, low decision authority and poor social support between 1991 and 2013 were calculated. Logistic regression analyses were performed to estimate variation across time, using 1991 as the reference category, and between industries, using knowledge intensive services as the reference category. Estimates for high job demands, low decision authority and poor social support were presented as average marginal effects (AMEs). RESULTS: The probabilities of reporting low decision authority were higher in education and health and social care during the whole study period, for both genders, compared with the reference category of knowledge intensive services. The probability of having high job demands were higher for men and women in education, and women in health and social care, compared with the reference category. Men in the male dominated industries had increased job demands over time, compared to the beginning of the study period (1991). The probability of reporting poor social support was higher in the later than in the earliest time period for women in the female-dominated industry health and social care as well as in the gender-mixed labour intensive services industry. CONCLUSIONS: There has been a negative development of job demands and decision authority in the female-dominated industries education and health and social care in Sweden, whereas social support has developed more negatively for women in health and social care and in labour intensive services.


Assuntos
Tomada de Decisões , Indústrias/organização & administração , Autonomia Profissional , Apoio Social , Carga de Trabalho/estatística & dados numéricos , Adolescente , Adulto , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Distribuição por Sexo , Suécia , Adulto Jovem
6.
Nurs Leadersh (Tor Ont) ; 32(1): 74-84, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31228346

RESUMO

Feelings of empowerment in nursing staff can contribute to increased job satisfaction, improved quality of care and a higher retention rate within healthcare organizations. Nursing is critical at healthcare organizations, with direct and significant impact on the quality of care provided; yet, nurses often feel undervalued for the work they do. The strength-based approach of appreciative inquiry is one way to engage individuals in finding collective value through the identification of successes, enabling the creation of a shared vision and strategy for the future.


Assuntos
Enfermeiras e Enfermeiros/psicologia , Atitude do Pessoal de Saúde , Hospitais Psiquiátricos/organização & administração , Hospitais Psiquiátricos/estatística & dados numéricos , Humanos , Satisfação no Emprego , Enfermeiras e Enfermeiros/estatística & dados numéricos , Poder (Psicologia) , Autonomia Profissional , Enfermagem Psiquiátrica/métodos
7.
Rev. Bras. Saúde Mater. Infant. (Online) ; 19(2): 471-479, Apr.-June 2019.
Artigo em Inglês | LILACS | ID: biblio-1013142

RESUMO

Abstract Objectives: to understand the cultural context presented in hospitals and its relation to the obstetric nurse's autonomous practice on low-risk childbirth care. Methods: ethnographic research performed in three public maternities in Rio Grande do Norte, Brazil. Three managers and twenty-three obstetric nurses participated in this research. Results: distinctive on cultural, organizational and structural aspects of the hospital institution interfering directly with the obstetric nurse's autonomous practice. Among these aspects, professional appreciation on low-risk childbirth care contributes for the nurse's autonomy Conclusions: it was noticed that obstetric nurses undergo different contexts of action, which directly interfere with their autonomy on low-risk childbirth care and their decisionmaking abilities. It is necessary, then, to eradicate the relation of dominance and submission that it is still imposed by medical hegemony.


Resumo Objetivos: compreender o contexto cultural da instituição hospitalar e sua relação com a prática autônoma do enfermeiro obstetra na assistência ao parto de risco habitual. Métodos: pesquisa etnográfica desenvolvida em três maternidades públicas do Estado do Rio Grande do Norte, Brasil, com três gestores e 23 enfermeiros obstetras. Resultados: diferentes aspectos de ordem cultural, organizacional e estrutural da instituição hospitalar interferem diretamente na prática autônoma do enfermeiro obstetra. Dentre estes aspectos, a valorização profissional na assistência ao parto de risco habitual contribui para a autonomia do profissional em questão. Conclusões: constatou-se que o enfermeiro obstetra vivencia distintos contextos de atuação, os quais interferem diretamente na sua autonomia na assistência ao parto de risco habitual e no seu poder de decisão. Faz-se necessário, então, desvencilhar-se das relações de domínio e submissão, ainda impostas pela hegemonia médica.


Assuntos
Humanos , Prática Profissional , Cultura Organizacional , Autonomia Profissional , Tocologia , Enfermeiras Obstétricas , Brasil , Enfermagem Holística , Parto Humanizado , Tomada de Decisões , Humanização da Assistência
8.
Rev Infirm ; 68(248): 16-18, 2019 Feb.
Artigo em Francês | MEDLINE | ID: mdl-30955531

RESUMO

Advanced practice is now possible in nursing practice in France. It is starting to be taught at university. Significant changes to practices are taking place in the short term, for nurses. In this context, it is interesting to look back at the foundations of nursing autonomy rooted in the origins of the scope of nursing practice.


Assuntos
Enfermagem , Autonomia Profissional , França , Humanos , Enfermagem/tendências
9.
Rev Bras Enferm ; 72(suppl 1): 41-48, 2019 Feb.
Artigo em Inglês, Português | MEDLINE | ID: mdl-30942343

RESUMO

OBJECTIVE: To know the aspects involved in the production of subjectivity and autonomy of nursing professionals working in Pediatric Units. METHOD: An exploratory and descriptive study, with a qualitative approach, performed with users, professionals and nursing managers, totaling 44 participants. Data collection took place in the pediatric hospitalization units of two University Hospitals through semi-structured interviews, organized and treated by Nvivo 10 software and then submitted to content analysis. RESULTS: The production of subjectivity and autonomy in nursing workers involves both the conditions of the work environment as the relation of the nursing team, the relation of hierarchy and the profile of the professional that works in the Pediatric Unit. FINAL CONSIDERATIONS: The valorization path of the nursing profession emerges, whose knowledge and competence in the area of work contribute to the construction of autonomous subjectivities.


Assuntos
Eficiência , Recursos Humanos de Enfermagem no Hospital/psicologia , Autonomia Profissional , Adulto , Feminino , Humanos , Entrevistas como Assunto/métodos , Pessoa de Meia-Idade , Recursos Humanos de Enfermagem no Hospital/normas , Enfermagem Pediátrica/normas , Pesquisa Qualitativa , Local de Trabalho/psicologia , Local de Trabalho/normas
10.
Artigo em Inglês | MEDLINE | ID: mdl-30986910

RESUMO

This study investigated job crafting as mediator and its relation with job satisfaction and work-family conflict, considering job autonomy as antecedent. The research involved 389 participants working in a public organization. A structural equations model was estimated revealing that job autonomy is positively associated with job crafting and job satisfaction, and negatively associated with work-family conflict. Job crafting is positively related with job satisfaction and work-family conflict, as adverse effect of job crafting. As regards mediated effects, results show positive associations between job autonomy and both job satisfaction and work-family conflict through job crafting. This study contributes to literature, considering positive and negative outcomes, covering the lacking literature on job crafting and work-family conflict, and suggesting implications for employees' well-being.


Assuntos
Conflito (Psicologia) , Emprego/psicologia , Conflito Familiar , Satisfação no Emprego , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Autonomia Profissional , Inquéritos e Questionários
11.
J Grad Med Educ ; 11(2): 207-213, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31024655

RESUMO

Background: There is ongoing tension in graduate medical education between progressive resident autonomy with entrustable professional activities and the need for supervision to ensure patient safety. Objective: We implemented a pediatric orthopedic surgical trauma safety program that utilized a postcall review conference to provide residents graduated responsibility learning opportunities during overnight trauma call without compromising patient safety. Methods: In the program, all orthopedic trauma cases seen in our main tertiary hospital emergency department by the overnight orthopedic resident were reviewed in a case conference. For 1 year, we performed an analysis of all fracture patients who were treated in the emergency department by our orthopedic surgery residents. From June 1, 2016, through June 30, 2017, all care delivery encounters were reviewed for decision-making errors, technical errors, and complication rates. Two resident groups rotated through our institution over the course of the study. Results: During the year of analysis, all 1298 fracture patients seen overnight in the main tertiary hospital emergency department were reviewed. From the first to the second halves of their rotations, the rate of resident decision-making errors (3.1% [12 of 385] to 2.3% [9 of 399]) and technical errors (9.1% [35 of 395] to 7.3% [29 of 399]) decreased. Excluding decision-making and technical errors, the complication rate for patients discharged home was 3.4% (27 of 784). Conclusions: Residents demonstrated decreased decision-making and technical error rates on overnight call while maintaining low complication rates.


Assuntos
Fraturas Ósseas/terapia , Internato e Residência/organização & administração , Erros Médicos/prevenção & controle , Ortopedia/educação , Criança , Competência Clínica , Tomada de Decisões , Educação de Pós-Graduação em Medicina/métodos , Fraturas Ósseas/complicações , Humanos , Internato e Residência/métodos , Ortopedia/normas , Segurança do Paciente , Pediatria/métodos , Autonomia Profissional , Centros de Atenção Terciária , Ferimentos e Lesões/terapia
12.
J Prof Nurs ; 35(2): 147-152, 2019 Mar - Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30902407

RESUMO

Nursing autonomy is an object of ongoing debate. Knowing how the next generation of nurses conceives of autonomy is essential, given its role in professional satisfaction and retention. The aim of this research was to understand how nursing students at the end of their nursing education view nursing autonomy. A qualitative study was conducted with third-year nursing students in Barcelona, Spain, using focus groups. A theme analysis was used and Guba's criteria of credibility, transferability, dependability and confirmability were applied. Three key themes emerged: 1) greater autonomy than expected; 2) historical increase in professional autonomy; and 3) confusion surrounding autonomy. Students' surpassed expectations and awareness of a historical increase in autonomy bode well for the profession. However, confusion about autonomy may lead to false expectations, which may cause some nurses to become frustrated and even leave the profession. Because this process occurs in a context of growing demand for nurses, understanding factors that affect hiring and retention is a priority. Strategies are needed to clarify new nurses' understanding of autonomy.


Assuntos
Atitude do Pessoal de Saúde , Autonomia Profissional , Estudantes de Enfermagem/psicologia , Adulto , Bacharelado em Enfermagem , Feminino , Grupos Focais , Humanos , Masculino , Pessoa de Meia-Idade , Lealdade ao Trabalho , Pesquisa Qualitativa , Espanha
13.
Cien Saude Colet ; 24(3): 705-714, 2019 Mar.
Artigo em Português, Inglês | MEDLINE | ID: mdl-30892493

RESUMO

The present study highlighted the labour process of the dental surgeon (DS) in the private healthcare sector from the healthcare professional's perspective based on intervention bioethics. An observational, cross-sectional survey study was performed within the Federal District (Distrito Federal) region. Data were collected from 108 questionnaires completed by DSs affiliated with two types of private health insurers, self-insurance and group insurance, to assess job perception and the degree of job satisfaction in the dentistry market. The main source of dissatisfaction for healthcare professionals was related to the pay for dental procedures by insurers. For self-insurer 1, 38.1% healthcare professionals replied that the pay was satisfactory, whereas in self-insurance 2 and in the group insurance, 100% of healthcare professionals were dissatisfied. Another finding was that the group insurer considerably restricted elective treatments. In conclusion, loss of professional autonomy, depreciation of insurance claims and precarisation of dentistry occurs in the private healthcare sector, thus demonstrating the ethical conflicts in this relationship.


Assuntos
Atitude do Pessoal de Saúde , Odontologia/organização & administração , Odontólogos/estatística & dados numéricos , Satisfação no Emprego , Bioética , Estudos Transversais , Odontólogos/economia , Odontólogos/psicologia , Setor de Assistência à Saúde/economia , Setor de Assistência à Saúde/organização & administração , Humanos , Seguro Saúde/economia , Setor Privado/economia , Setor Privado/organização & administração , Autonomia Profissional , Inquéritos e Questionários
14.
Artigo em Inglês | MEDLINE | ID: mdl-30857145

RESUMO

Retaining proactive employees with the potential to be high performers is recognized as an essential condition for an organization's survival and prosperity. However, few studies have logically explained and empirically clarified the link between proactive personality, which represents a distal proactive tendency, and turnover intention to predict actual turnover behavior. With the research objective to address these research gaps, we expected that work engagement as a proximal motivational mechanism was likely to mediate the relationship between proactive personality and turnover intention, and that job autonomy as a critical job context was likely to moderate the relationship between proactive personality and work engagement. We developed a moderated mediation model incorporating these expectations. The results of the survey conducted on employees working for mid-sized manufacturing firms in Korea were consistent with our expectations. The findings of this study help uncover the intentions of turnover exhibited by proactive employees.


Assuntos
Intenção , Satisfação no Emprego , Lealdade ao Trabalho , Reorganização de Recursos Humanos , Autonomia Profissional , Adulto , Estudos Transversais , Feminino , Humanos , Masculino , Personalidade , República da Coreia , Inquéritos e Questionários , Engajamento no Trabalho
15.
J Allied Health ; 48(1): 22-30, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30826827

RESUMO

PURPOSE: Awareness of global issues and cultural competence are essential for health professions students. Educational programs utilize International Service Learning (ISL) to address global issues and diverse cultures. This study describes short- and long-term benefits of ISL on Doctor of Physical Therapy (DPT) students. PROCEDURES: The ISL included study of Ayurveda, clinical service, collaborative learning, and cultural activities. A mixed-methods design included the Cross Cultural Adaptability Index (CCAI) administered to 14 students pre- and post-ISL and qualitative analysis of reflective papers. Interviews of participants were completed 2 to 3 years later. FINDINGS: Overall CCAI scores showed a statistically significant difference of 0.001 (p<0.01) pre and post ISL. Three subscales also showed a statistically significant difference (p<0.01). Qualitative analysis of reflective papers revealed three categories of impact: environmental connectedness, personal growth, and professional growth. Interviews conducted years following the ISL indicate that participants attribute several aspects of their professional and personal way of being to the ISL, including the importance of whole person care. CONCLUSIONS: Studies have shown benefits to health professions students immediately following an ISL. This study demonstrates that benefits persist years later. The long-term impact strengthens the rationale for including ISL during professional education.


Assuntos
Competência Cultural , Educação de Pós-Graduação/organização & administração , Intercâmbio Educacional Internacional , Fisioterapia/educação , Aprendizagem Baseada em Problemas/organização & administração , Estudantes/psicologia , Comportamento Cooperativo , Meio Ambiente , Humanos , Índia , Medicina Ayurvédica/métodos , Autonomia Profissional , Pesquisa Qualitativa , Resiliência Psicológica
16.
Br J Nurs ; 28(4): 266, 2019 Feb 28.
Artigo em Inglês | MEDLINE | ID: mdl-30811234

RESUMO

Gabriella Gilbert, who recently completed her studies to become a fully fledged staff nurse, shares her final reflections on her journey to registration.


Assuntos
Adaptação Psicológica , Emoções , Enfermeiras e Enfermeiros/psicologia , Autonomia Profissional , Estudantes de Enfermagem/psicologia , Medo , Humanos
17.
Res Nurs Health ; 42(2): 136-147, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30807664

RESUMO

In this study, we examined the influence of professional network characteristics, available professional support, and perceived support quality on intent to stay among for-profit nursing home (NH) directors of nursing (DON). We hypothesized that the receipt of high quality professional support would be associated with DON intent to stay. DONs have a critical mandate to provide leadership that influences their facilities' work climate and care quality. Yet, they often struggle to manage overwhelming responsibilities and are left feeling alienated, frustrated, and intent on leaving their jobs. Professional support, accessed via professional networks, may help DONs combat frustration and mitigate turnover that threatens NH care quality. Using a descriptive survey design, we electronically surveyed all DONs employed by a single for-profit NH corporation to collect data pertaining to their professional networks, receipt of professional support, perceptions regarding support quality, and intentions to stay in their positions. One-hundred-ninety-five DONs (65%) responded, with 133 (44%) completing every survey component. We employed social network analysis methods to construct datasets linking descriptors of DON respondents with attribute information about 1,164 network members. Statistical analyses (ANOVAs, point biserial correlations, and binomial logistic regression) yielded several findings supporting our hypothesis: (i) DONs' professional networks closely resembled the teams in which they worked daily; (ii) DONs relied on this core network of individuals to provide task support primarily; (iii) DON-nursing home administrator relationships were most important; and (iv) perceptions of support quality and support from nursing home administrators were the strongest predictors of DON intent to stay.


Assuntos
Atitude do Pessoal de Saúde , Liderança , Enfermeiras Administradoras/psicologia , Casas de Saúde/organização & administração , Apoio Social , Carga de Trabalho/psicologia , Humanos , Relações Interprofissionais , Reorganização de Recursos Humanos , Autonomia Profissional
18.
J Nurs Educ ; 58(2): 72-78, 2019 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-30721306

RESUMO

BACKGROUND: Sound nursing clinical judgment is at the core of competent and safe client care. New graduate nurses face increasing challenges that underscore the importance of investigating how nurse educators teach and measure nursing students' abilities to make clinical judgments. This article presents the National Council of State Boards of Nursing-Clinical Judgment Model (NCSBN-CJM) and discusses the use of the model. METHOD: A multidisciplinary team conducted a qualitative comparative analysis of the relationships between the NCSBN-CJM and the three leading frameworks for providing clinical judgment education to entry-level nurses. RESULTS: The NCSBN-CJM aligns with the Information-Processing Model and the Intuitive-Humanistic Model. The NCSBN-CJM also can be used to assess the Dual Process Reasoning Theory. CONCLUSION: The NCSBN-CJM can assist nurse educators in designing effective tools for assessing clinical judgment by helping them target specific cognitive operations. This flexible model expresses the complexities associated with decision making in a simplified manner to enable better measurement of clinical judgment. [J Nurs Educ. 2019;58(2):72-78.].


Assuntos
Competência Clínica/normas , Julgamento , Licenciamento em Enfermagem/normas , Modelos Educacionais , Autonomia Profissional , Humanos , Modelos de Enfermagem , Enfermeiras Clínicas/educação , Profissionais de Enfermagem/educação , Pesquisa em Educação de Enfermagem , Política Organizacional , Estudantes de Enfermagem , Estados Unidos
20.
Rev Esp Salud Publica ; 932019 Jan 21.
Artigo em Espanhol | MEDLINE | ID: mdl-30662061

RESUMO

OBJECTIVE: The catalan primary care (PC) management model is differentiated from the rest of regional autonomies because it has a greater diversity of providers The objective was to explore and compare management models according to the primary care provider in Catalonia based on the professionals' vision. METHODS: An online survey was carried out on February 1st 2017 to March 17th 2017 and structured in 6 sections that explored filiation, organization, accessibility, resolution, leadership and commitment. The analysis compares the answers grouped by entity providing Primary Health Care (PHC) services in Catalonia: Institut Català de la Salut (ICS), Public Consortium (CP), Public Consortium that also manages Hospital (CPH), Associative Base Entities (EBA) and Private Entities. The continuous variables were analyzed with the ANOVA test, and the categorical ones with chi-square or Fisher's exact test. RESULTS: T1474 responses were obtained, female gender was 78,1%, mean age was 48 years. 90% were doctors or nurses, 87% working in non-rural environments and 71% in ICS. The professionals of EBA declared greater ease (79.1%) and recognition (76.1%) for the development of professional skills, delay under 72h in scheduled appointments (83.9%) and increased self-management of agenda (87.5%). 54.2% of Public Consortium professionals (CP) and 55.4% of EBApresented high access to diagnostic tests and advanced nurse management of demand, 54.2% and 51.8%, respectively. It was highlighted a greater commitment, in entities with greater possibility of agenda self-management, a plan for training professional activities, objectives recognition, feedback on the activity results and EBA. CONCLUSIONS: The management models of PHC providers determine different characteristics. The most favourable answers to autonomous management, resolution, accessibility and commitment stand out in the EBA and CP professionals group who answered the survey.


Assuntos
Equipe de Assistência ao Paciente/organização & administração , Atenção Primária à Saúde/organização & administração , Adulto , Feminino , Pesquisas sobre Serviços de Saúde , Acesso aos Serviços de Saúde/organização & administração , Humanos , Liderança , Masculino , Pessoa de Meia-Idade , Autonomia Profissional , Espanha
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